This document discusses the importance of preoperative assessment and premedication in anesthesia. It outlines the goals of the preoperative visit including assessing fitness for anesthesia and optimizing medical conditions. The document describes taking an anesthetic history and physical examination, with a focus on evaluating the cardiovascular, respiratory and airway systems. It discusses using tests like Mallampati scoring and thyromental distance to predict potential airway difficulties. The document also covers determining appropriate preoperative investigations and developing an anesthetic plan tailored to each patient's needs.
This document provides an overview of preoperative anesthetic assessment and premedication. It discusses the objectives of the preoperative evaluation, which includes obtaining a full medical history and physical exam and understanding how patient comorbidities may impact the anesthetic plan. Key aspects of the history that are covered include cardiovascular, respiratory, neurological and other medical conditions, as well as drug allergies and social history. Elements of the physical exam like airway assessment are also outlined. Guidelines for additional preoperative testing and medical referrals are provided. Factors that increase perioperative mortality risk are noted. The goals and components of informed consent, premedication and the perioperative patient journey are summarized.
The document discusses the goals and process of a preanaesthetic evaluation. The anaesthesiologist aims to optimize the patient's medical condition, assess fitness for anaesthesia, and identify any risks. They take a full medical history, examine the patient, and order relevant investigations. For higher risk patients, evaluation may involve multiple specialists and days of preparation. The anaesthesiologist discusses the planned anaesthetic with the patient and obtains consent. Premedication is sometimes used to reduce anxiety, secretions, nausea/vomiting, or enhance the effects of anaesthesia.
The document discusses peri-operative care, outlining the three phases: pre-operative, intra-operative, and post-operative care. It describes pre-operative care as including patient assessment, history, examinations, investigations, and preparation. Key aspects of pre-operative care are evaluating patient risk factors, medical history, and physical status to determine fitness for surgery and identify risks. The document also discusses classifications of surgery cleanliness and urgency, as well as common post-operative complications.
This document discusses the important aspects of pre-operative patient preparation and assessment. It outlines the key components of taking a patient history, performing a physical exam, identifying relevant comorbidities, and ordering appropriate pre-operative tests and investigations. Special focus is given to evaluating and optimizing patients' cardiovascular and pulmonary systems to reduce perioperative risk. The goals are to identify any issues that could impact the surgical outcome and to optimize medical conditions in order to decrease complications.
1. Pre-operative preparation begins at initial patient contact and aims to optimize patient outcomes through thorough assessment, medical optimization, risk evaluation, and informed consent.
2. A complete history, physical exam, and relevant lab/imaging investigations are used to evaluate any medical issues and surgical risks. Comorbidities like cardiovascular or respiratory diseases require specialized management.
3. High-risk patients undergo detailed optimization, including treating infections, stabilizing medications, and potentially admitting to critical care post-operatively. Proper pre-op skin/hair preparation, antibiotic prophylaxis timing, and elimination help reduce surgical site infections.
PRE-OPERATIVE AND INTRA-OPERATIVE CARE OF THE ANESTHESIA PATIENT group 8-2.pptxDakaneMaalim
1. The document discusses pre-operative and intra-operative care of anesthesia patients, outlining factors like history, physical exam, labs, and risk assessment that are important to evaluate patients.
2. Key parts of evaluation include assessing airway, cardiovascular and respiratory systems, medications, allergies, and relevant medical history.
3. The goals are to decrease risks and complications, make plans for anesthesia, and optimize patient condition and education prior to surgery.
The document provides guidance on preoperative anesthesia evaluations. It discusses why evaluations are important for patients, anesthesiologists, and surgeons. The evaluation should obtain a thorough medical history, physical exam including airway assessment, review medications and labs/tests needed based on surgery risk. Comorbidities like diabetes and hypertension are addressed. The goal is to optimize patient health and develop an anesthetic plan to reduce risks during surgery.
medical evaluation of the surgical patientAmit Shrestha
The document provides guidelines for preoperative medical evaluation and optimization of surgical patients. It discusses grading surgical risk, collecting patient history and health information, assessing cardiac and pulmonary risk, managing common comorbidities like diabetes, and recommending prophylaxis for infections and blood clots. Key aspects include using standardized questionnaires; evaluating risk factors like age, functional status and clinical markers; providing preventative therapies like beta blockers and statins as needed; and implementing measures to reduce pulmonary and thrombotic complications through the pre-, intra-, and postoperative periods.
This document provides an overview of preoperative anesthetic assessment and premedication. It discusses the objectives of the preoperative evaluation, which includes obtaining a full medical history and physical exam and understanding how patient comorbidities may impact the anesthetic plan. Key aspects of the history that are covered include cardiovascular, respiratory, neurological and other medical conditions, as well as drug allergies and social history. Elements of the physical exam like airway assessment are also outlined. Guidelines for additional preoperative testing and medical referrals are provided. Factors that increase perioperative mortality risk are noted. The goals and components of informed consent, premedication and the perioperative patient journey are summarized.
The document discusses the goals and process of a preanaesthetic evaluation. The anaesthesiologist aims to optimize the patient's medical condition, assess fitness for anaesthesia, and identify any risks. They take a full medical history, examine the patient, and order relevant investigations. For higher risk patients, evaluation may involve multiple specialists and days of preparation. The anaesthesiologist discusses the planned anaesthetic with the patient and obtains consent. Premedication is sometimes used to reduce anxiety, secretions, nausea/vomiting, or enhance the effects of anaesthesia.
The document discusses peri-operative care, outlining the three phases: pre-operative, intra-operative, and post-operative care. It describes pre-operative care as including patient assessment, history, examinations, investigations, and preparation. Key aspects of pre-operative care are evaluating patient risk factors, medical history, and physical status to determine fitness for surgery and identify risks. The document also discusses classifications of surgery cleanliness and urgency, as well as common post-operative complications.
This document discusses the important aspects of pre-operative patient preparation and assessment. It outlines the key components of taking a patient history, performing a physical exam, identifying relevant comorbidities, and ordering appropriate pre-operative tests and investigations. Special focus is given to evaluating and optimizing patients' cardiovascular and pulmonary systems to reduce perioperative risk. The goals are to identify any issues that could impact the surgical outcome and to optimize medical conditions in order to decrease complications.
1. Pre-operative preparation begins at initial patient contact and aims to optimize patient outcomes through thorough assessment, medical optimization, risk evaluation, and informed consent.
2. A complete history, physical exam, and relevant lab/imaging investigations are used to evaluate any medical issues and surgical risks. Comorbidities like cardiovascular or respiratory diseases require specialized management.
3. High-risk patients undergo detailed optimization, including treating infections, stabilizing medications, and potentially admitting to critical care post-operatively. Proper pre-op skin/hair preparation, antibiotic prophylaxis timing, and elimination help reduce surgical site infections.
PRE-OPERATIVE AND INTRA-OPERATIVE CARE OF THE ANESTHESIA PATIENT group 8-2.pptxDakaneMaalim
1. The document discusses pre-operative and intra-operative care of anesthesia patients, outlining factors like history, physical exam, labs, and risk assessment that are important to evaluate patients.
2. Key parts of evaluation include assessing airway, cardiovascular and respiratory systems, medications, allergies, and relevant medical history.
3. The goals are to decrease risks and complications, make plans for anesthesia, and optimize patient condition and education prior to surgery.
The document provides guidance on preoperative anesthesia evaluations. It discusses why evaluations are important for patients, anesthesiologists, and surgeons. The evaluation should obtain a thorough medical history, physical exam including airway assessment, review medications and labs/tests needed based on surgery risk. Comorbidities like diabetes and hypertension are addressed. The goal is to optimize patient health and develop an anesthetic plan to reduce risks during surgery.
medical evaluation of the surgical patientAmit Shrestha
The document provides guidelines for preoperative medical evaluation and optimization of surgical patients. It discusses grading surgical risk, collecting patient history and health information, assessing cardiac and pulmonary risk, managing common comorbidities like diabetes, and recommending prophylaxis for infections and blood clots. Key aspects include using standardized questionnaires; evaluating risk factors like age, functional status and clinical markers; providing preventative therapies like beta blockers and statins as needed; and implementing measures to reduce pulmonary and thrombotic complications through the pre-, intra-, and postoperative periods.
The document discusses guidelines for pre-anesthetic evaluation. It outlines the objectives of pre-anesthetic evaluation as assessing the patient's medical condition, optimizing risks for anesthesia, and obtaining informed consent. Key components of evaluation include medical history, physical exam assessing airway and cardiovascular/respiratory systems, lab tests, and ASA physical status classification. Guidelines are provided for pre-op fasting, medication management, documentation, and conducting evaluations via interview or questionnaires.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
preoperative preparation and postoperative care Sabrina AD
The document discusses preoperative preparation and postoperative care. It covers patient assessment, risk assessment and consent, arranging the theatre list, preoperative problems and referrals, and management of specific medical conditions like cardiovascular disease, respiratory disease, gastrointestinal disease, genitourinary disease, endocrine disorders, and more. The goal is to optimize patients medically, identify and address risks, and ensure safe surgery.
This document provides guidance on preoperative patient evaluation and preparation. It discusses evaluating various organ systems, including cardiovascular, pulmonary, and renal systems. Key tests and considerations are outlined for optimizing patient health prior to surgery and reducing perioperative risk, such as checking for anemia, kidney function, or cardiac stress testing depending on patient history and planned procedure. The goal is to identify any issues that could impact the surgical outcome and develop strategies to address areas of concern before surgery.
This document provides guidance on preoperative patient evaluation and preparation. It discusses evaluating various organ systems, including cardiovascular, pulmonary, and renal systems. Key tests and considerations are outlined for optimizing patient health prior to surgery and reducing perioperative risk, such as checking for anemia, kidney function, or cardiac stress testing depending on patient history and comorbidities. The goal is to identify any issues that could impact the surgical outcome and develop strategies to address them before the procedure.
The document discusses postoperative care and chest complications. It covers several key points:
1) Respiratory complications occur in up to 15% of major surgeries and can negatively impact outcomes through increased mortality, morbidity, hospitalization duration, and costs.
2) Patients face respiratory risks in the immediate postoperative period from issues like atelectasis, pulmonary edema, and respiratory failure due to changes in lung volumes and function.
3) Preventing postoperative pulmonary complications requires evaluating patient risk factors, optimizing pre- and postoperative pulmonary status through measures like smoking cessation, treating infections, and encouraging deep breathing exercises.
1. The document summarizes the key aspects of preoperative preparation, including gathering a thorough medical history, conducting a focused physical exam, ordering appropriate tests and labs, ensuring medical optimization and risk mitigation, reviewing anesthesia options, and obtaining informed consent from the patient.
2. Important considerations include assessing cardiovascular, respiratory, gastrointestinal and other systems; planning for high-risk patients; communicating with the surgical team; and discussing risks, benefits and alternatives with the patient.
3. Preparation involves ensuring nothing by mouth guidelines are followed, IV access is obtained, and prophylaxis is provided for issues like DVT.
Pre anaesthesia checkup-history new.pptxsushma510192
The document discusses the importance of pre-anesthesia evaluation. It aims to identify patients who may benefit from preoperative optimization, determine if the proposed surgery is appropriate given a patient's condition, and help plan the anesthetic approach. Key aspects of evaluation are reviewing the cardiovascular, pulmonary, neurological, hepatic, renal, endocrine and coagulation systems. Conditions like diabetes, hypertension, coronary artery disease are evaluated in detail. The goals are to ensure patients are optimized and risks are identified to minimize perioperative complications.
The document discusses the importance of pre-anesthesia evaluation. It aims to identify medical conditions that could impact anesthesia, guide anesthetic planning, obtain consent, and assess surgical risk. Key aspects of evaluation include reviewing the cardiovascular, pulmonary, renal, hepatic, neurological, and respiratory systems. Assessing issues like hypertension, coronary artery disease, diabetes, smoking history helps determine a patient's perioperative risk. The goal is to optimize high-risk patients' conditions before elective surgery and determine if a procedure's risks outweigh its benefits for very sick patients.
This document provides guidance on patient assessment prior to surgery. It outlines the importance of correcting medical issues like anemia and diabetes, as well as gaining an understanding of a patient's history and comorbidities to estimate surgical risks. The assessment involves taking a thorough history, conducting an examination, and ordering relevant investigations. High-risk patients are identified and their management is optimized to reduce postoperative morbidity and mortality. The document provides detailed guidance on assessing various organ systems and comorbidities, and developing perioperative management plans tailored to individual patient needs and risks.
Diagnosis in endodontics Sunil M Eraly Malabar Dental College and Research ...sunileraly
This document provides information on diagnosis in endodontics. It discusses the importance of taking a thorough medical and dental history from the patient, including their chief complaint, symptoms, and relevant risk factors. A variety of clinical tests are described to objectively examine the tooth, including neural sensitivity tests, pulp vascularity tests, and radiography. Taking all available subjective and objective findings into account helps the clinician formulate an accurate diagnosis and appropriate treatment plan.
The document discusses preoperative assessment in anesthesia. It defines preoperative evaluation as the clinical assessment done before anesthesia delivery for surgery or other procedures. The goals of preoperative evaluation are to assess risk, develop an anesthesia plan, optimize the patient's condition, and document medical history. The evaluation involves medical history taking, physical exam including airway assessment, and ordering relevant tests. Proper preoperative evaluation can decrease morbidity, mortality and costs.
This document provides guidance on preoperative evaluation and preparation of patients undergoing anesthesia and surgery. It discusses performing a thorough history and physical exam to assess any medical conditions or risks that could impact anesthesia. The goals are to reduce patient risk, modify care as needed, and improve surgical outcomes. Key organ systems to evaluate include respiratory, cardiovascular, neurological, and endocrine. Relevant lab tests may be ordered depending on physical findings. The document also provides guidelines on preoperative preparation for conditions like diabetes and use of steroids to optimize patient health and safety during the perioperative period.
This document provides an overview of preoperative evaluation and preparation. It discusses taking a thorough patient history and conducting a physical exam, with a focus on assessing the airway and risk factors. Preoperative tests and investigations are recommended based on patient age and type of surgery. Risk stratification tools like the ASA classification and cardiac risk indices are presented. Guidelines are provided for medication management and NPO restrictions prior to surgery. The goals of preoperative evaluation are identified as optimizing patient health and reducing perioperative risks.
Preanesthetic evaluation of patients in oral and maxillofacial surgeryPunam Nagargoje
The word is derived from the Greek words an, which means “without” and aithesia which means “feeling”
The use of medical anesthesia was first reported in 1846
The development of anesthesia has made today’s modern surgical techniques possible
• Basic Principles of Anesthesia
• “Triad of General Anesthesia”
need for unconsciousness
need for analgesia
need for muscle relaxation and loss of reflexes
• Preoperative Evaluation
• The preanesthetic evaluation has specific objectives including:
- Establishing a doctor-patient relationship,
- Becoming familiar with the surgical illness and
- coexisting medical conditions,
- Anticipating potential complication
Developing a management strategy for perioperative anesthetic care,
- Obtaining informed consent for the anesthetic plan.
The overall goals of the preoperative assessment are to reduce perioperative morbidity and mortality and to allay patient anxiety.
• Pre-operative
This applied both in evaluation & investigations
• General
This include the following:
1-General condition of the patient.
2-Psychological condition. ( Specially in major operations).
• Specific
This include the following:
1-Related to anaesthesia.
2-Related to the surgery.
• Medical History
1. Review the chart
2. Review previous records
3. Interview the patient
• Demographic Data
Height / weight
Vital signs
Diagnosis
History and Physical Exam
Note any abnormalities
Don’t assume that all problems are listed
• Steps of the preoperative visit :
• Preoperative testing should be performed on a selective basis for purposes of guiding or optimizing perioperative management.
• Pre-op Testing Schema Example
• Preoperative Laboratory Testing:
• only if indicated from the preoperative history and physical examination.
• "Routine or standing" pre operative tests should be discouraged
• -CBC anticipated significant blood loss, suspected hematological disorder (eg.anemia, thalassemia, SCD), or recent chemotherapy.
• -Electrolytes diuretics, chemotherapy, renal or adrenal disorders
• -ECG age >50 yrs ,history of cardiac disease, hypertension, peripheral vascular disease, DM, renal, thyroid or metabolic disease.
• -Chest X-rays prior cardiothoracic procedures ,COPD, asthma, a change in respiratory symptoms in the past six months.
• -Urine analysis DM, renal disease or recent UTI.
• -tests for different systems according to history and examination
• Disease-based indications
Alcohol abuse
CBC, ECG, lytes, LFTs, PT
Anemia
CBC
Bleeding disorder
CBC, LFTs, PT, PTT
Cardiovascular
CBC, creatinine, CXR, ECG, lytes
• Disease-based indications
Cerebrovascular disease
Creatinine, glucose, ECG
Diabetes
Creatinine, electrolytes, glucose, ECG
Hepatic disease
CBC, creatinine, lytes, LFTs, PT
• Disease-based indications
Pregnancy (controversial)
Serum B-hCG- 7 days, Upreg 3 days
Pulmonary disease
CBC, ECG, CXR
Renal disease
CBC, Cr, lytes, ECG
RA
CBC, ECG, CX
Primary and secondary survey379487438.pptAnnaya Khan
The document outlines the process for initially assessing and managing a multiply injured patient. This includes conducting a primary survey to identify life-threatening conditions like airway obstruction, breathing issues, hemorrhage and disability using ABCDE. Resuscitation efforts like securing the airway, oxygenation, IV fluids and hemorrhage control are performed simultaneously. Next, a secondary survey involves a full physical exam, patient history and diagnostic testing to identify all injuries. The patient is then monitored and stabilized before transfer for definitive care and surgical intervention if needed. Repeated assessments are important to detect any deterioration.
This document discusses guidelines for pre-anesthesia evaluation (PAE). It outlines the components of a PAE, including history taking, physical examination, and relevant investigations. It emphasizes assessing risk factors for perioperative complications, especially related to cardiovascular and pulmonary systems. Modifications to PAE processes during the COVID-19 pandemic are also reviewed, such as taking precautions like masks and distancing.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
The document discusses guidelines for pre-anesthetic evaluation. It outlines the objectives of pre-anesthetic evaluation as assessing the patient's medical condition, optimizing risks for anesthesia, and obtaining informed consent. Key components of evaluation include medical history, physical exam assessing airway and cardiovascular/respiratory systems, lab tests, and ASA physical status classification. Guidelines are provided for pre-op fasting, medication management, documentation, and conducting evaluations via interview or questionnaires.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
preoperative preparation and postoperative care Sabrina AD
The document discusses preoperative preparation and postoperative care. It covers patient assessment, risk assessment and consent, arranging the theatre list, preoperative problems and referrals, and management of specific medical conditions like cardiovascular disease, respiratory disease, gastrointestinal disease, genitourinary disease, endocrine disorders, and more. The goal is to optimize patients medically, identify and address risks, and ensure safe surgery.
This document provides guidance on preoperative patient evaluation and preparation. It discusses evaluating various organ systems, including cardiovascular, pulmonary, and renal systems. Key tests and considerations are outlined for optimizing patient health prior to surgery and reducing perioperative risk, such as checking for anemia, kidney function, or cardiac stress testing depending on patient history and planned procedure. The goal is to identify any issues that could impact the surgical outcome and develop strategies to address areas of concern before surgery.
This document provides guidance on preoperative patient evaluation and preparation. It discusses evaluating various organ systems, including cardiovascular, pulmonary, and renal systems. Key tests and considerations are outlined for optimizing patient health prior to surgery and reducing perioperative risk, such as checking for anemia, kidney function, or cardiac stress testing depending on patient history and comorbidities. The goal is to identify any issues that could impact the surgical outcome and develop strategies to address them before the procedure.
The document discusses postoperative care and chest complications. It covers several key points:
1) Respiratory complications occur in up to 15% of major surgeries and can negatively impact outcomes through increased mortality, morbidity, hospitalization duration, and costs.
2) Patients face respiratory risks in the immediate postoperative period from issues like atelectasis, pulmonary edema, and respiratory failure due to changes in lung volumes and function.
3) Preventing postoperative pulmonary complications requires evaluating patient risk factors, optimizing pre- and postoperative pulmonary status through measures like smoking cessation, treating infections, and encouraging deep breathing exercises.
1. The document summarizes the key aspects of preoperative preparation, including gathering a thorough medical history, conducting a focused physical exam, ordering appropriate tests and labs, ensuring medical optimization and risk mitigation, reviewing anesthesia options, and obtaining informed consent from the patient.
2. Important considerations include assessing cardiovascular, respiratory, gastrointestinal and other systems; planning for high-risk patients; communicating with the surgical team; and discussing risks, benefits and alternatives with the patient.
3. Preparation involves ensuring nothing by mouth guidelines are followed, IV access is obtained, and prophylaxis is provided for issues like DVT.
Pre anaesthesia checkup-history new.pptxsushma510192
The document discusses the importance of pre-anesthesia evaluation. It aims to identify patients who may benefit from preoperative optimization, determine if the proposed surgery is appropriate given a patient's condition, and help plan the anesthetic approach. Key aspects of evaluation are reviewing the cardiovascular, pulmonary, neurological, hepatic, renal, endocrine and coagulation systems. Conditions like diabetes, hypertension, coronary artery disease are evaluated in detail. The goals are to ensure patients are optimized and risks are identified to minimize perioperative complications.
The document discusses the importance of pre-anesthesia evaluation. It aims to identify medical conditions that could impact anesthesia, guide anesthetic planning, obtain consent, and assess surgical risk. Key aspects of evaluation include reviewing the cardiovascular, pulmonary, renal, hepatic, neurological, and respiratory systems. Assessing issues like hypertension, coronary artery disease, diabetes, smoking history helps determine a patient's perioperative risk. The goal is to optimize high-risk patients' conditions before elective surgery and determine if a procedure's risks outweigh its benefits for very sick patients.
This document provides guidance on patient assessment prior to surgery. It outlines the importance of correcting medical issues like anemia and diabetes, as well as gaining an understanding of a patient's history and comorbidities to estimate surgical risks. The assessment involves taking a thorough history, conducting an examination, and ordering relevant investigations. High-risk patients are identified and their management is optimized to reduce postoperative morbidity and mortality. The document provides detailed guidance on assessing various organ systems and comorbidities, and developing perioperative management plans tailored to individual patient needs and risks.
Diagnosis in endodontics Sunil M Eraly Malabar Dental College and Research ...sunileraly
This document provides information on diagnosis in endodontics. It discusses the importance of taking a thorough medical and dental history from the patient, including their chief complaint, symptoms, and relevant risk factors. A variety of clinical tests are described to objectively examine the tooth, including neural sensitivity tests, pulp vascularity tests, and radiography. Taking all available subjective and objective findings into account helps the clinician formulate an accurate diagnosis and appropriate treatment plan.
The document discusses preoperative assessment in anesthesia. It defines preoperative evaluation as the clinical assessment done before anesthesia delivery for surgery or other procedures. The goals of preoperative evaluation are to assess risk, develop an anesthesia plan, optimize the patient's condition, and document medical history. The evaluation involves medical history taking, physical exam including airway assessment, and ordering relevant tests. Proper preoperative evaluation can decrease morbidity, mortality and costs.
This document provides guidance on preoperative evaluation and preparation of patients undergoing anesthesia and surgery. It discusses performing a thorough history and physical exam to assess any medical conditions or risks that could impact anesthesia. The goals are to reduce patient risk, modify care as needed, and improve surgical outcomes. Key organ systems to evaluate include respiratory, cardiovascular, neurological, and endocrine. Relevant lab tests may be ordered depending on physical findings. The document also provides guidelines on preoperative preparation for conditions like diabetes and use of steroids to optimize patient health and safety during the perioperative period.
This document provides an overview of preoperative evaluation and preparation. It discusses taking a thorough patient history and conducting a physical exam, with a focus on assessing the airway and risk factors. Preoperative tests and investigations are recommended based on patient age and type of surgery. Risk stratification tools like the ASA classification and cardiac risk indices are presented. Guidelines are provided for medication management and NPO restrictions prior to surgery. The goals of preoperative evaluation are identified as optimizing patient health and reducing perioperative risks.
Preanesthetic evaluation of patients in oral and maxillofacial surgeryPunam Nagargoje
The word is derived from the Greek words an, which means “without” and aithesia which means “feeling”
The use of medical anesthesia was first reported in 1846
The development of anesthesia has made today’s modern surgical techniques possible
• Basic Principles of Anesthesia
• “Triad of General Anesthesia”
need for unconsciousness
need for analgesia
need for muscle relaxation and loss of reflexes
• Preoperative Evaluation
• The preanesthetic evaluation has specific objectives including:
- Establishing a doctor-patient relationship,
- Becoming familiar with the surgical illness and
- coexisting medical conditions,
- Anticipating potential complication
Developing a management strategy for perioperative anesthetic care,
- Obtaining informed consent for the anesthetic plan.
The overall goals of the preoperative assessment are to reduce perioperative morbidity and mortality and to allay patient anxiety.
• Pre-operative
This applied both in evaluation & investigations
• General
This include the following:
1-General condition of the patient.
2-Psychological condition. ( Specially in major operations).
• Specific
This include the following:
1-Related to anaesthesia.
2-Related to the surgery.
• Medical History
1. Review the chart
2. Review previous records
3. Interview the patient
• Demographic Data
Height / weight
Vital signs
Diagnosis
History and Physical Exam
Note any abnormalities
Don’t assume that all problems are listed
• Steps of the preoperative visit :
• Preoperative testing should be performed on a selective basis for purposes of guiding or optimizing perioperative management.
• Pre-op Testing Schema Example
• Preoperative Laboratory Testing:
• only if indicated from the preoperative history and physical examination.
• "Routine or standing" pre operative tests should be discouraged
• -CBC anticipated significant blood loss, suspected hematological disorder (eg.anemia, thalassemia, SCD), or recent chemotherapy.
• -Electrolytes diuretics, chemotherapy, renal or adrenal disorders
• -ECG age >50 yrs ,history of cardiac disease, hypertension, peripheral vascular disease, DM, renal, thyroid or metabolic disease.
• -Chest X-rays prior cardiothoracic procedures ,COPD, asthma, a change in respiratory symptoms in the past six months.
• -Urine analysis DM, renal disease or recent UTI.
• -tests for different systems according to history and examination
• Disease-based indications
Alcohol abuse
CBC, ECG, lytes, LFTs, PT
Anemia
CBC
Bleeding disorder
CBC, LFTs, PT, PTT
Cardiovascular
CBC, creatinine, CXR, ECG, lytes
• Disease-based indications
Cerebrovascular disease
Creatinine, glucose, ECG
Diabetes
Creatinine, electrolytes, glucose, ECG
Hepatic disease
CBC, creatinine, lytes, LFTs, PT
• Disease-based indications
Pregnancy (controversial)
Serum B-hCG- 7 days, Upreg 3 days
Pulmonary disease
CBC, ECG, CXR
Renal disease
CBC, Cr, lytes, ECG
RA
CBC, ECG, CX
Primary and secondary survey379487438.pptAnnaya Khan
The document outlines the process for initially assessing and managing a multiply injured patient. This includes conducting a primary survey to identify life-threatening conditions like airway obstruction, breathing issues, hemorrhage and disability using ABCDE. Resuscitation efforts like securing the airway, oxygenation, IV fluids and hemorrhage control are performed simultaneously. Next, a secondary survey involves a full physical exam, patient history and diagnostic testing to identify all injuries. The patient is then monitored and stabilized before transfer for definitive care and surgical intervention if needed. Repeated assessments are important to detect any deterioration.
This document discusses guidelines for pre-anesthesia evaluation (PAE). It outlines the components of a PAE, including history taking, physical examination, and relevant investigations. It emphasizes assessing risk factors for perioperative complications, especially related to cardiovascular and pulmonary systems. Modifications to PAE processes during the COVID-19 pandemic are also reviewed, such as taking precautions like masks and distancing.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
RPMS TEMPLATE FOR SCHOOL YEAR 2023-2024 FOR TEACHER 1 TO TEACHER 3
1. anesthetic assesment & Premedication.ppt
1. Preoperative Anaesthetic
Assessment and Premedication
19/ 10 / 2014
Dr. Jumana. M. Baaj
Ass. professor , Anesthesia consultant
Dept. of Anesthesia
KKUH- KSU
Riyadh, Saudi Arabia
3. Stages of the Peri-Operative Period
Pre-Operative
• From time of decision
to have surgery until
admitted into the OR
theatre.
4. Stages of the Peri-Operative Period
Intra-Operative
• Time from entering the
OR theatre to entering
the Recovering Room or
Post Anesthetic Care
Unit (PACU)
5. Stages of the Peri-Operative Period
Post-Operative
• Time from leaving the
RR or PACU until
time of follow-up
evaluation (often as
out-patient)
7. The anesthetic plan
Type of anesthesia
General
Airway management
Induction
Maintenance
Muscle relaxation
Sedation
Supplemental oxygen
Agents
Local or regional anesthesia
Technique
Agents
8. The anesthetic plan
Intraoperative management
Monitoring
Positioning
Fluid management
Special techniques
Postoperative
Pain control
Intensive care
Postoperative ventilation
Hemodynamic monitoring
9. The preoperative visit of all patients
by an anesthetist is an essential
requirement for the safe and
successful conduct of anaesthesia
10. The preoperative visit
• Main aim is to assess the patient's fitness for
anaesthesia
• The Best to be performed by an anaesthetist
• Preferably the one who is going to administer the
anaesthetic
11. The preoperative visit
visit allows
– Best anaesthetic technique
– Any potential interactions between concurrent
diseases
– Anaesthesia anticipated
– Provides an explanation
– Reassurance for the patient
12. Coexisting Illness
– Improve the patients condition prior to surgery
– Seeking advice from other specialists
– Optimise treatment
– Final decision .
The preoperative visit
13. • Three situations where special arrangements
are usually made
1-Patients with complex medical or surgical
problems
• patient is often admitted several days before surgery
• anaesthetist is actively involved in optimising their
condition prior to anaesthesia and surgery
2-Surgical emergencies
only a few hours separates admission and operation in
these patients urgent investigations or treatment
14. 3-Day-case patients
• These are patients who are planned
• Generally ‘fitter’ ASA1 or ASA 2
• Assessment in anesthesia clinic
16. Anaesthetic history and examination
Anaesthetist should take a full history &
Examine each patient
17. PREVIOUS ANAESTHETICS AND OPERATIONS
• Hospitals
• Enquire about inherited or 'family' diseases
– sickle-cell disease
– porphyria
• Difficulties with previous anaesthetics
– nausea
– vomiting
– dreams
– awareness
– postoperative jaundice
18. PREVIOUS ANAESTHETICS AND OPERATIONS
• Present & past medical history
– all the aspects of the patient's medical history
– relating to the cardiovascular and respiratory systems and its severity
19. Cardiovascular system
• Specific enquiries must be made about:
– Angina
• incidence
• precipitating factors
• duration
• use of anti-anginal medications, e.g. glyceryl trinitrate (GTN)
oral or sublingual )
– Previous myocardial infarction and subsequent
symptoms
– Symptoms indicating heart failure
20. Cardiovascular system
– myocardial infarction are at a greater risk of
perioperative reinfarction
– Elective surgery postponed until at least 6
months after the event
– Untreated or poorly controlled hypertension
(diastolic consistently > 110 mmHg) may lead
to exaggerated cardiovascular responses
– Both hypertension and hypotension can be
precipitated which increase the risk
of myocardial ischemia
21. Cardiovascular system
– Heart failure will be worsened by the depressant
effects impairing the perfusion of vital organs
– valvular heart disease
* ? prosthetic valves may be on anticoagulants --
need to be stopped or changed prior to surgery
* Antibiotic prophylaxis
22. Active Cardiac Conditions
• Unstable coronary syndromes
– Unstable or severe angina
– Recent MI
• Decompensated HF
• Significant arrhythmias
• Severe valvular disease
23. Minor Cardiac Predictors
• Advanced age (>70)
• Abnormal ECG
– LV hypertrophy
– LBBB
– ST-T abnormalities
– Rhythm other than sinus
• Uncontrolled systemic hypertension
24.
25. Surgical Risk Stratification
• High Risk
– Vascular (aortic and major vascular)
• Intermediate Risk
– Intraperitoneal and intrathoracic, carotid, head
and neck, orthopedic, prostate
• Low Risk
– Endoscopic, superficial procedures, cataract,
breast, ambulatory surgery
26. Respiratory system
– Patients with pre-existing lung disease
prone to postoperative chest infections if they
are obese or undergoing upper abdominal or
thoracic surgery
chronic obstructive lung disease production of
sputum (volume and color)
Dyspnoea
asthma, including precipitating factor
upper respiratory tract infection
anaesthesia and surgery should be postponed
unless it is for a life-threatening condition
27. Other conditions in the medical history
– Indigestion
– heartburn
– reflux
• may indicate the possibility of a hiatus hernia
– Rheumatoid disease
• chronically anaemic
• severely limited movement of their joints
• makes positioning for surgery and airway maintenance
difficult.
• Tendency for dislocation of atalnto-occiptal joint
28. Other conditions in the medical history
– Diabetes
• Patients have an increased incidence of
– ischaemic heart disease
– renal dysfunction
– autonomic and peripheral neuropathy
• intra- and postoperative complications
– Neuromuscular disorders
• Care with muscle relaxants
• Coexisting heart disease
• restrictive pulmonary disease
29. Other conditions in the medical history
– Chronic renal failure
• anaemic
• electrolyte abnormalities
• altered drug excretion
• restricts the choice of anaesthetic agents
– Jaundice
• infective or obstructive liver disease
• Drug metabolism altered
• coagulation must be checked
– Epilepsy
• well controlled or not
• avoid anaesthetic agents potentially epileptogenic (e.g.
enflurane)
30. Family history
• All patients should be asked
– inherited conditions in the family
– history of prolonged apnoea
– unexplained death
– malignant hyperpyrexia
– Surgery postponed
31. DRUG HISTORY AND ALLERGIES
• Identify all medications
– Prescribed
– self-administered
– Allergies to drugs
• topical preparations (e.g. iodine)
• adhesive dressings
• foodstuffs
32. SOCIAL HISTORY
• Smoking
– number of cigarettes
– amount of tobacco
nicotine stimulates the sympathetic nervous system
• causing tachycardia
• hypertension
• coronary artery narrowing
• Alcohol
– induction of liver enzymes
– tolerance
33. SOCIAL HISTORY
– Difficulty with venous access
– Thrombosis of veins
– Withdrawal syndromes
– Look for tattooing also
36. THE EXAMINATION
Cardiovascular system
– dysrhythmias
– atrial fibrillation
– heart failure
– heart murmur
– valvular heart disease
– blood pressure is best measured at the end of the
examination
37. THE EXAMINATION
Respiratory system
– cyanosis
– pattern of ventilation
– respiratory rate
– Dyspnoea
– Wheeziness
– signs of collapse
– consolidation and effusion
38. THE EXAMINATION
Nervous system
– Chronic disease of the peripheral and central nervous
systems
– evidence of motor or sensory impairment recorded
– dystrophic myotonica
39. THE EXAMINATION
Musculoskeletal
– restriction of movement and deformities
– reduced muscle mass
– peripheral neuropathies
– pulmonary involvement
– Particular attention to the patient's cervical spine and
temporomandibular joints
40. THE EXAMINATION
The airway
– Try and predict difficult intubation
– Assessment is often made in three stages
1. Observation of the patient's anatomy
• Look for limitation of mouth opening, receding mandible
position, number and health of teeth, size of tongue.
• Examine the front of the neck for soft tissue swellings,
deviated larynx or trachea.
• Check the mobility of the cervical spine in both flexion and
extension.
43. THE EXAMINATION
2. Simple bedside tests
- Mallampati criteria
- Thyromental distance - < 7 cm suggests difficult
intubation
3. X-rays
- lateral X-ray of the head and neck
- reduced distance between the occiput and the spinous
process of C 1 (< 5 mm) and an increase in the posterior
depth of the mandible (> 2.5 cm)
None of these tests, alone or in combination,
predict all difficult intubations
44.
45. Airway Evaluation
• Jaw Movement
– Both inter-incisor gap and
anterior subluxation
– <3.5cm inter-incisor gap
concerning
– Inability to sublux lower
incisors beyond upper
incisors
• Receding mandible
• Protruding Maxillary
Incisors (buck teeth)
47. THE EXAMINATION
2. Simple bedside tests
- Wilson score
- Mallampati criteria
- Thyromental distance - < 7 cm suggests difficult
intubation
3. X-rays
- lateral X-ray of the head and neck
- reduced distance between the occiput and the spinous
process of C 1 (< 5 mm) and an increase in the posterior
depth of the mandible (> 2.5 cm)
None of these tests, alone or in combination,
predict all difficult intubations
49. THE EXAMINATION
2. Simple bedside tests
- Wilson score
- Mallampati criteria
- Thyromental distance - < 7 cm suggests difficult intubation
3. X-rays
- lateral X-ray of the head and neck
- reduced distance between the occiput and the spinous process
of C 1 (< 5 mm) and an increase in the posterior depth of the
mandible (> 2.5 cm)
None of these tests, alone or in combination,
predict all difficult intubations
53. Special Investigations
• If no concurrent disease, investigations can be
limited as:
Baseline investigations
Age
<40
<40
41-60
41-60
>61
Sex
Male
Female
Male
Female
All
Investigations
Nil
Hb
ECG, Blood sugar, creatinine
Hb, ECG, Blood sugar, creatinine
Hb, ECG, Blood sugar, creatinine
54. ADDITIONAL INVESTIGATIONS
• Urea and electrolytes
– in patients taking digoxin
– diuretics
– diabetes, renal disease
– vomiting
– diarrhoea
• Liver function tests
– hepatic disease
– high alcohol
– metastatic disease
– evidence of malnutrition
63. INCREASED RISK OF MORTALITY
• Inadequate preoperative preparation including
resuscitation
• Lack of and inappropriate monitoring during surgery
• Poor postoperative care, including lack of intensive
care beds
• Inadequate supervision of trainees
64. Mortality related to anaesthesia
• Approx 1:26,000 anaesthetics
• One third of deaths are preventable
• Causes in order of frequency
– inadequate patient preparation
– inadequate postoperative management
– wrong choice of anaesthetic technique
– inadequate crisis management
65. ANAESTHETIC ASSOCIATED DEATHS
• Increasing age: >60 years
• Sex: male > female
• Worsening physical status
• Increasing number of concurrent medical conditions,
in particular:
– myocardial infarction
– diabetes mellitus
66. ANAESTHETIC ASSOCIATED DEATHS
• renal disease
• Increasing complexity of surgery:
– intracranial
– major vascular
– intrathoracic
• Increasing length of surgery
• Emergency operations
67. ASA PHYSICAL STATUS SCALE
Class Physical status
I A healthy patient with no organic or
psychological disease process. The
pathological process for which operation is
performed is localized and causes no systemic
upset
II A patient with a mild to moderate systemic disease
process caused by the condition to be treated
surgically or other pathological process which does not limit
the patient's activities in any way, e.g. treated hypertensive,
stable diabetic. Patients aged >80 years are automatically
placed in class 11
68. ASA PHYSICAL STATUS SCALE
Class Physical status
III A patient with severe systemic disease from any cause which
imposes a definite functional limitation on activity, e.g. ischaemic heart
disease, chronic obstructive lung disease
IV A patient with a severe systemic disease which is a constant threat to
life, e.g. unstable angina
V A moribund patient, unlikely to survive 24 hours with or without surgery
Note:'E' maybe added to signify an emergency operation.
69. ASA STATUS AND POSTOPERATIVE MORTALITY
ASA class Absolute mortality (I) Crude mortality per
10 000 anaesthetics
I
II
III
IV
V
0.1
0.2
1.8
7.8
9.4
7.2
19.7
115.1
766.2
3358.0
71. Informing the patient
Anaesthetist has only a brief time Explain the events to
the patient (preoperative period )
Most patients will want to know how long starved prior
to surgery in terms of eating and drinking
72. Informing the patient
The choice of anaesthetic technique rests
with the anaesthetist, but most patients
appreciate some details of what to expect
73. Informing the patient
• patients will ask about their immediate recovery
• Finally
– reassure patients about postoperative pain control
– informed of the technique
• Consent for anaesthesia
75. The 6 As of premedication
• Anxiolysis – the best anxiolytic is the anesthetist
who visits the patient and listens to the patient
• Amnesia
• Anti-emetic
• Antacid
• Anti-autonomic
• Analgesic
78. • Antacid
• Patients who have received opiates
• present as emergencies
• If in pain
• delayed gastric emptying
• hiatus hernia
– Oral sodium citrate
– Ranitidine , Proton inhibitors
– Metoclopramide
– naso- or orogastric tube
Premedication
79. • Anti-autonomic
– Parasympathetic reflexes
• Excessive vagal activity causing profound bradycardia
• halothane
• suxamethonium
• surgery
• traction on the extraocular muscles
• handling of the viscera
• during elevation of a fractured zygoma
Premedication